ice9 Profile picture
3 Dec, 6 tweets, 2 min read
More evidence that endothelial cells are not directly vulnerable to infection by SARS-CoV-2.

Endothelial dysfunction in COVID-19 is entirely indirect. Image
Discussion thread on pericytes, nearby susceptible cells strongly suspected to mediate some of the damage.

Discussion on infection of pulmonary megakaryocytes, i.e. platelet-forming cells, also strongly suspected of involvement.

Article on immunothrombosis, a pathological state in which the local inflammatory response particularly in the lungs drives endothelial dysfunction and progressive microthrombosis:

Discussion thread on influence of elevated plasma 5-HT (serotonin) in promoting endothelial dysfunction:

Further discussion of indirect causes of endothelial dysfunction in COVID-19, from a previous thread on the apparent resistance of endothelial cells to infection by SARS-CoV-2:

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More from @__ice9

3 Dec
People want ironclad proof for everything. It doesn't exist. It never will. Even the best trials only apply to a certain stage of the disease in a certain set of the population at a certain dose with a certain baseline standard of care.
One must weigh evidence and combine signals in a safe way. That is all.
"First, the only certainty is that there is no certainty. Second, every decision, as a consequence, is a matter of weighing probabilities. Third, despite uncertainty we must decide and we must act."
Read 4 tweets
1 Dec
More evidence inflammasome activation predicts severe COVID-19, and acts as a major driver of disease progression.

They release IL-1β, which summons neutrophils and promotes (highly pro-thrombotic) NETosis, plus IL-18, which prompts IFNγ secretion (very inflammatory, apoptotic).
In layman's terms:

Certain virally infected or antigen-swamped white blood cells smash their emergency self-destruct button, explode, and release huge amounts of signaling molecules that summon exploding neutrophils and tell other classes of WBCs to order nearby cells to die.
This strongly contributes to the severe lung clotting and often serious broader lung tissue damage that define the state we call "severe COVID-19."
Read 4 tweets
1 Dec
@Deadly_Statins it's pretty nasty. the systemic inflammatory response is intense and can hit hard and fast. not a cold or flu at all. not like anything I've ever caught before. glad I was able to abort it.
@Deadly_Statins trying very hard not to catch it again. basically just hiding out in my residence as much as possible.
@Deadly_Statins the percentage of people with active infections out in public right now is obscene; it would be apocalyptic if IFR were higher.

unfortunately because there are so many of them, hospitals are turning people away and IFR *is* getting higher, slowly, inexorably.
Read 4 tweets
28 Nov
So far, N=5 cytokine panels from post-acute COVID-19 patients with persistent inflammatory sequelae all show the same basic pattern:

- TNFα ⬇️
- IL-4 ⏫
- IL-13 ⬇️
- IL-2 ⬆️
- GM-CSF ⏬✨
- CCL3 ⏫
- IL-6 ⏫
- IL-10 ⏫
- IFN-γ ⏫✨
- CCL4 ⬇️
Sorting a bit differently:

- TNFα ⬇️
- IFN-γ ⏫✨
- IL-2 ⬆️
- IL-4 ⏫
- IL-6 ⏫
- IL-10 ⏫
- IL-13 ⬇️
- CCL3 ⏫
- CCL4 ⬇️
- GM-CSF ⏬✨

One discussion on the subject:


Last image that didn't fit above:
Read 4 tweets
22 Nov
@drakchaurasia @poiThePoi @GephenS @youyanggu @mattparlmer A combination of quercetin, bromelain, and vitamin C succeeded in an antiviral prophylactic RCT. This surprised me.

Ivermectin works in antiviral prophylaxis RCTs, likely by enhancing T cell response.

Aspirin is effective for thromboprophylaxis in general. Dipyridamole too.
@drakchaurasia @poiThePoi @GephenS @youyanggu @mattparlmer Arbidol (umifenovir) 200mg t.i.d. succeeded in a Chinese antiviral prophylactic study.

Interferon alpha nasal and pharyngeal spray succeeded in another Chinese prophylactic study.

Hydroxychloroquine shows limited impact for post-exposure prophylaxis, partial for pre-exposure.
@drakchaurasia @poiThePoi @GephenS @youyanggu @mattparlmer Combining ambroxol/bromhexine with hydroxychloroquine is extremely likely to be effective in pre- or post-exposure prophylaxis.

Note long-term ambroxol/bromhexine use is known to be safe in e.g. COPD.

Unfortunately they must be used 2-3 times per day, much like Arbidol or IFN.
Read 9 tweets
22 Nov
One of various ways in which COVID-19 is indeed not 'just the flu.'
... and here, if so inclined, one can see physically what that actually looks like--

Some other autopsy studies, organizing these links to keep the imagery limited to those indeed so inclined.

Read 4 tweets

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